Hodges' Model: Welcome to the QUAD: anorexia

Hodges' model is a conceptual framework to support reflection and critical thinking. Situated, the model can help integrate all disciplines (academic and professional). Amid news items, are posts that illustrate the scope and application of the model. A bibliography and A4 template are provided in the sidebar. Welcome to the QUAD ...

Showing posts with label anorexia. Show all posts
Showing posts with label anorexia. Show all posts

Tuesday, November 26, 2024

The naïve approach ii - Seeking / Avoiding a Catastrophe

In addition to Dodson's book I borrowed:

Zeeman, E.C. (1977) Catastrophe Theory-Selected Papers 1972–1977, Reading, MA: Addison-Wesley.

From the mid-1970s I remember catastrophe theory rather bursting on to the science scene. Articles in New Scientist (in a box somewhere?), Scientific American plus a BBC TV episode of Horizon (seeking details - originally aired July 28, 1975, 60 minutes 'Happy Catastrophe')*, that highlighted potential for new insights into the behaviour inside prisons. and other applications in the social sciences.

The CONTENTS reads:
GENERAL INTRODUCTORY PAPERS 

1. Catastrophe theory : Draft for a Scientific American article 1
2. Levels of structure in catastrophe theory 65

 BIOLOGICAL SCIENCES 80

3. Differential equations for the heartbeat and nerve impulse 81 
4. Primary and secondary waves in developmental biology 141 
5. A clock and wavefront model for the control of repeated structures during animal morphogenesis (with J.Cooke) 235
6. Gastrulation and formation of somites in amphibia and birds (Addendum by R. Bellairs.) 257 
7. Dialogue between a Biologist and a Mathematician 267 
8. Brain modelling 287 
9. Duffing's equation in brain modelling 293

 SOCIAL SCIENCES 302

10. Some models in the social sciences (with C.A.Isnard) 303 
11. On the unstable behaviour of stock exchanges 361 
12. Conflicting judgements caused by stress 373 
13. A model for institutional disturbances (with C.S.Hall, P.J.Harrison, G.H.Marriage, P.H.Shapland) 387
14. Prison disturbances 403 

PHYSICAL SCIENCES 408 

15. A catastrophe machine 409
16. Euler buckling 417 
17. Stability of ships 441

MATHEMATICS 496

18. The classification of elementary catastrophes of codimension <= 5 (with D.J.A.Trotman) 497
19. The umbilic bracelet and the double-cusp catastrophe 563 

DISCUSSION 604

20. Research ancient and modern 605 
21. Catastrophe theory : its present state and future perspectives (with R.Thom) 615
22. Afterthought 651 
As an area of contention the subject of catastrophe theory (CT) possibly presents(?) a dual-cusp of contention. Firstly, CT brought with it controversy within academia and mathematics. The book was reviewed by T. W. Barrett, Department of Physiology and Biophysics, University of Tennessee Center for the Health Sciences, Memphis, TN 38163: 
'Catastrophe theory (CT), as a new field in mathematics with many possible ramifications for both the physical and biological sciences, has recently been the subject of much controversy (see [1]-[5]). This controversy, in this reviewer's opinion, has served a valuable purpose insofar as it has stimulated the theory's proponents to refine and delineate their concepts more clearly. Catastrophe theory was developed by the Field prize winner, Rene Thom; but much work has been accomplished by E. C. Zeeman and his group, especially with respect to applications.' pp.609-610. IEEE TRANSACTIONS ON SYSTEMS, MAN, AND CYBERNETICS, VOL. SMC-9, NO. 9, SEPTEMBER 1979. https://ieeexplore.ieee.org/stamp/stamp.jsp?arnumber=4310286 
Stephen Smale also reviewed Zeeman's book; BULLETIN OF THE AMERICAN MATHEMATICAL SOCIETY Volume 84, Number 6, November 1978. 1360-1368. 
https://www.ams.org/journals/bull/1978-84-06/S0002-9904-1978-14580-7/S0002-9904-1978-14580-7.pdf
'To write a review in this environment has a very personal side for me. On one hand my own work on dynamical systems is closely connected to the origins of CT. I have had a long and close personal and professional relationship with both Thorn and Zeeman. More than 20 years ago I was discussing singularities of maps, transversality, and immersions with René Thom. Thom tried to interest me in an early draft of chapters of his book Structural stability and morphogenesis in 1966.

On the other hand I have remained skeptical and aloof from CT, perhaps due to my conservatism in science. While my colleagues and students were showing enthusiasm for CT, I gave critical lectures, one at the University of Chicago in 1974, one at the Aspen Institute of Physics in 1975. More recently I have been quoted negatively in the "Science" and New York Times references above. This is the first time I have written on the subject, and I should warn the reader of this negative bias, far from shared by many of my fellow mathematicians.' p.1360.

Some defenders of CT may accuse me of discussing very special examples not characteristic of the literature of the subject. I feel that the problem of lack of justification discussed above, is also found in Zeeman's other models. Furthermore Thorn's models are even less specific and less developed. On the other hand, Thorn's work in CT covers many subjects; in this connection Zeeman writes in his Scientific American article, April 1976, p. 65: "The method has the potential for describing the evolution of form in all aspects of nature, and hence it embodies a theory of great generality."' p.1366.
The book's introductory papers are somewhat confusing in content, as drawn to 'SOCIAL SCIENCES' it is the introductory section (and Part Two) that includes  'Anorexia nervosa', Example 9 pp.33-52. 

This is the second 'cusp' as the assessment, diagnosis, intervention, outcomes, skilled staff, access to specialised mental health services remains contentious to this day. As a charge nurse on a female acute admission mental health ward in the early 1980s, eating disorders have always presented a 'clinical' challenge. Often within a staff group and for individual staff members too.

Twitter/X is hardly an objective record but it appears today, that people and families affected by eating disorder continue to advocate for appropriate service provision, treatment and recognition. Recognition that can also develop evidence-based interventions. As discussed by Dr. Agnes Ayton, consultant psychiatrist and others in the video below:


A related paper:

Ibrahim, A., Ryan, S., Viljoen, D. et al. Integrated enhanced cognitive behavioural (I-CBTE) therapy significantly improves effectiveness of inpatient treatment of anorexia nervosa in real life settings. J Eat Disord 10, 98 (2022). https://doi.org/10.1186/s40337-022-00620-y [ My source: @AgnesAyton ]

The Zeeman chapter on anorexia nervosa is interesting graphically and conceptually ...

Page 42. Figure 20. The effect of the butterfly factor, d>0.
(Sorry for the image quality)

- but is of course 'from another time' and is clearly not person-centred. Eating disorders affect many people in the UK and are a cause of trauma, distress, disrupted life-chances and mortality. Referring to Hodges' model, such graphics, reinforce the idea that 'solutions' are to be found in the mechanistic and quantitative domains of the sciences and politics (choice, power, services, safety..). Here, maths and theories (seemingly) provide an explanation for people who are ill, and need treatment. As a teenager for most of the 1970s, Hodges' model was not yet a reality. As I have found since 1987-8 looking at the POLITICAL care/knowledge domain, the model's relevance has increased since the start of my nursing career in 1977. Consider for example, the politics of:
  • the global phenomena of famine
  • - whether or not associated with economic crisis, drought, other natural disaster, or conflict, political crisis
  • ultra-processed foods
  • obesity pandemic
  • weight loss drugs
  • appetite stimulants
  • appetite suppressants
  • eating disorder (anorexia and bulimia) across care sectors - primary, secondary, specialist
    • community / in-patient care
    • person-centred care
    • user involvement in service design
  • the availability of treatment modalities - psychotherapy (as in the video)
  • the impact on family relationships and peer group (estranged - loss of friends)
  • diagnostic blurring - psychosis, borderline personality disorder - the rise of 'anti-psychiatry'
Here then is the purpose of this post, what potential is there to look at nutrition from a situated individual and collective (global) perspective? This could be focussed on nutrition, or eating disorder; or alternately take a collective stance to encompass the global food supply and the industry. Discovering the diffeomorphism, I wonder if there are others, and their respective properties and character? 

INDIVIDUAL
|
INTERPERSONAL : SCIENCES              
humanistic ------------------------------- mechanistic
SOCIOLOGY : POLITICAL   
|
GROUP
COGNITIVE THERAPY
EMPATHY&RAPPORT
LISTENING - MUTUAL ENGAGEMENT
MENTAL HEALTH
DIAGNOSIS
TRAINED / SKILLED STAFF
EVIDENCE-BASED INTERVENTIONS*
MOTIVATION
MOOD
MULTIMORBIDITY

RESEARCH
EATING
DIET
NUTRITION
NUTRITIONAL VALUE
WEIGHT
BMI
IN-PATIENT UNIT
place of safety


PUBLIC HEALTH
SOCIETY
FAMILY
CARERS


Developed nations
are collectively and increasingly
'eating disordered'
and exporting this 'lifestyle'.



Before I return the book, I will revisit the discussion section.

See also:
Jones P, Wirnitzer K. Hodges’ model: the Sustainable Development Goals and public health – universal health coverage demands a universal framework. BMJ Nutrition, Prevention & Health 2022;5:doi: 10.1136/bmjnph-2021-000254

*I could not find on BBC website. I have contacted the Open University. I did find - 'In this Horizon episode, Rene Thom's mathematical discovery of the catastrophe theory is investigated.' at  https://thetvdb.com/series/horizon/episodes/1385431

Tuesday, September 03, 2019

CLEAR as a Mental Health Million...?

individual
|
INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group - population
ASK 
about underlying social problems

TREAT
 the immediate health problem
...

REFER
to local social support resources

ADVOCATE
for


Constantly rationalising; it's still the Northern summer holidays, people are away, not everyone's on twitter, the tweet's still warm, blimey - get a life ...!

I wonder how no one else can consider the very obvious 'fit' between key elements of the CLEAR initiative and Hodges' model, sufficient to consider the tweet of that post worthy of a like at least? Not a one. (There's another post perhaps..?)

Oh well... Plough on ...

The other week Mental Health Million on twitter featured a gif that caught my eye again today. This graphic provides a lesson that also incorporates CLEAR.

If we consider the ASK advice, then this supposes of course that the person, patient, client is engaged with the health professional. Engaged, to such an extent that in competency terms the professional's interpersonal skills come to the fore. It really is how we ask, and at that first encounter that is crucial.

individual
|
INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group - population
ASK 
about underlying social problems

TREAT
 the immediate health problem
...

REFER
to local social support resources

ADVOCATE
for

Although I may write about the importance of parity of esteem in mental and physical health this is often thought of in funding, research terms and the physical health of people with more chronic forms of mental illnesses who are prescribed and take long term psychotropic medication. It is not easy to envisage the extent of the challenges for patients, their families and the health and social care team. The CLEAR website notes the use of the initiative across many health contexts and hence conditions, including dementia.

The animation tweeted by Mental Health Million and their reference to the 'One in Four' statistic, highlights the complex nature of 'care pathways'.

Yes, the solutions are "out there" but the key is making them available.

No pun intended, but pathways are often taken for granted in the sense that they are CLEARed and straightforward to follow. CLEAR checks this assumption and takes a global approach. CLEAR and Hodges' model draw attention to the humanistic, the social side of medicine, health care. These are often not factored in from the outset, as a vital part of the outcome process (policy, purposes and practices).

As mental health care professionals realise that ability to 'ask' can be hard-won in terms of the patience that needs to be exercised.
The counterpoint to that is a twitter thread last week. A person with mental illness and in difficulty at that time, was suggesting that the professionals "Go Away" (not exactly the words used).

As this animation suggests, getting referred is one thing, being heard and seen is another. Getting to the point were dialogue is possible is a delicate negotiation. Mutual respect, being able to agree to disagree. Do we agree as to the type of the fruit on the tree; never mind what might be 'low-hanging'?  Whatever the perceived and actual differences we must try to reduce that distance, listen, share and make progress.

No one should have to sit, walk, Be alone if they do not want to. ...


individual
|
INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group - population




TREAT
the immediate health problem


REFER
to local social support resources



ADVOCATE
for

Saturday, April 01, 2017

Models: Are out of fashion aren't they?

individual
|
INTERPERSONAL : SCIENCES
humanistic --------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group


My sources:
Eleanor Mills, February 5 2017, The Sunday Times.
Books: Size Zero: My Life As a Disappearing Model by Victoire Dauxerre